Lavage improves surgery for locally advanced gastric cancer

  • Guo J & al.
  • JAMA Surg
  • 27 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Extensive intraoperative peritoneal lavage (EIPL) during D2 gastrectomy for locally advanced gastric cancer leads to better short-term outcomes than surgery alone.

Why this matters

  • The study is the first to show that EIPL can reduce complications, wound pain, and mortality associated with D2 gastrectomy.

Study design

  • 550 patients from 11 centers in China were randomly assigned to surgery alone or surgery plus EIPL.
  • Funding: Sun Yat-sen University Cancer Center.

Key results

  • 5 postoperative deaths occurred in the surgery-alone group, 0 in surgery + EIPL (difference, 1.9%; P=.02).
  • Postoperative abdominal pain was more common with surgery alone (17.7% vs 10.8%; P=.02).
  • Among 550 patients who underwent gastrectomy, surgery alone vs surgery + EIPL:
    • ≥1 postoperative complication, 17.0% vs 11.1%; P=.04.
    • Ileus, 6.3% vs 5.0%.
    • Intra-abdominal abscess, 1.9% vs 0.7%.
    • Intra-abdominal bleeding, 2.6% vs 1.1%.
    • Wound problems, 2.6% vs 1.8%.
    • Deep-vein thrombosis, 0.7% vs 0%.
    • Postoperative cardiac disease, 0.7% vs 0%.
    • Postoperative pulmonary disease, 3.3% vs 2.5%.

Limitations

  • Some patients were excluded due to T1, T2, or M1 disease.

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